| NPI | 1528065448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: WI 52899-020) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: VA 0101028358) |
| 2085R0001X Radiology Radiation Oncology (Licence: PA 015496) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2022-05-14 |